An Unusual Presentation of Parathyroid and Micro Papillary Thyroid Carcinoma

Abstract Background: Parathyroid carcinoma is a rare endocrine malignancy, that usually presents with parathyroid hormone elevations five to ten times higher than normal. It rarely diagnosed in cases normal or mildly elevated PTH. Clinical Case: 68 yo female history of Hypertension, Spontaneous Vocal Cord Paralysis, Multinodular Goiter, Breast cancer s/p right radical mastectomy/chemotherapy, and Osteoporosis who presented outpatient Endocrine clinic for hypercalcemia. Medications include Coreg 12.5 mg BID. Patient was asymptomatic. Labs showed BUN 21 mg/dL [8 - 27 mg/dL], Creatinine 0.82 [0.57 1 eGFR 74 ml/min/1.73 m2 [nl>59 m2], Calcium 10.8 [8.7 10.3 Phosphorus 3 [3 4.3 Magnesium 2.2 [1.6 2.3 PTH 77 pg/mL [15 65 pg/mL], Albumin 4.2 g/dL [3.8 4.8 g/dL], Vitamin D 1,25 Dihydroxy 47.2 [19.9 79.3 25-OH 18.2 ng/mL Low [30 100 ng/mL], TSH 1.599 uIU/mL (.450-5.330 uIU/mL), Hgb 13.4 g /dL (12.0 -16.0 g/dL). Most recent FNA 2019 dominant thyroid nodule benign. Bone Density Scan June 2020 T score -3.4 the lumbar spine -3.1 left hip. Sestamibi inferior adenoma. Following ENT consultation, patient underwent surgical exploration. Pathology tissue extensive fibrosis, consistent Carcinoma (1.8 x .7cm), probable positive margins, nodular growth pattern individual nodules separated by fibrous bands, capsular invasion, focally, into adjacent adipose invading through capsule, perineural invasion Ki67 approximately six percent. Right lobe excision should micro focus papillary (.2 .2 cm), capsulated, negative pT1a. Conclusion: This case demonstrated an unusual presentation causing mild elevation level pathology after unexpectedly revealed along carcinoma.